TRICARE

[kbVA 5]

I have Tricare Standard - so I can self-refer. I've gone to two different initial consults with doctors AND have talked with Tricare myself of course, but I'm getting two different stories about how it all works from these offices.

Office 1: psych eval NOT covered - self pay

nutrition appointments covered - must take 3 consecutive months (surgery can't be any sooner than 90 days)

Office 2: psych eval covered

nutrition NOT covered - self pay & nutritionist appointments required but that they can be done quicker than the 3 months if you want to progress a little faster

Calling Tricare myself today confirms what the Office 2 said but then again, other times I've called Tricare I've heard slightly different especially about the 3 month waiting period and what that really means.

Just wondering if anyone has real life experience working with Tricare. I am on a bit of time crunch in terms of the flexibility of scheduling. I'd like to get this done around July so my mom can come out and help with the kids before she returns to work. I'm just not sure how possible this all will be without some outside help so my husband can be with me - my mom is very supportive of the surgery so I know she'll be great to have around post-op as well.

[pinkypearly1908 16]

Sorry I dont have Tricare, but Office 1 was my experience with Federal Bluecross BlueShield. (Im a civilian) I could never get a straight answer on how much all this was going to cost, so for me the decision came down to if I really wanted to do this for me. The answer was yes so I was determined to make it happen. At some point I decided that I just had to go for it. I also thought the 90 days waiting was a bit ridiculous but the time went fast, you get a bunch of tests, scans, bloodwork and nutritional classes that prepare you for success with what will be a big change to your body. Sorry I couldnt be of more help, but I hope this provides you with some insight.

[tanjasdad 1]

I have Tricare Prime and they paid for the psychological evaluation. They do not cover the sleeve, but do cover a gastric bypass.

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[tanjasdad 1]

I had the bypass last month. The Tricare Prime I use is the western version run by United Healthcare. Maybe they have different plans. Also I'm a retiree,

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[Doc'sWife 56]

With the sleeve it all depends on the facility. If you are going to an MTF that has a Bariatric program then it will be covered but from what I understand if you have to go out in town then they won't cover the sleeve. I have gone both routes. Try finding written covered benefits. I want to say the last time I saw it still wasn't covered tho.

Good luck :/

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[tanjasdad 1]

I had mine at a civilian hospital. I used Tricare as my secondary insurance.

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[tanjasdad 1]

I had the bypass, my first insurance would have covered the sleeve but Tricare wouldn't. I had the bypass because if was covered by both insurance plans.

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[Cinnamon16 18]

I have Tricare Prime and my surgery is on May 18th. I have not seen the final ok but the doctor I am working with said it should be no problem and they have many Tricare patients.

I can get the sleeve or bypass. The sleeve is new to their list for approval.

I asked my primary care for a referral and I had it in less than a week. I researched the area for the surgeon I wanted to go with and checked on their website that they worked with Tricare. The doctor I am using is listed in the Tricare as a general surgeon.

The long wait was for an opening with this doctor. Once I got in his office together he and Tricare required:

One appointment with psych. (This is covered under Tricare Prime).

One appointment with a nutritionist. (This was not covered and I paid $75 to see the nutricianist in his office).

An appointment with my primary to be released for surgery. (Regular copay).

An appointment at the hospital for prep (blood work, ecg... No copay)

If you are getting the sleeve my doctor requires an endoscopy to make sure you are good. (I don't think this was a Tricare requirement).

The surgeons office just called and asked me to start on some Vitamin B12, D and Iron due to my blood work. They seem sure I am good to get the surgery in 3 weeks. I am staying optimistic and will update when I more info or if anyone has any questions...

[reinventingmyself 47]

I have tricare prime and had surgery 2 mths ago. However, I had mine at MTF so my program covered everything. Only thing not offered there was psych eval and Tricare prime covered that with no hesitation. Since I did it at mtf, I did not have to wait 3-6 mths that Tricare make some wait. My Dr. referred me for sleeve and I was sleeved 2 mths later. I had no complications what-so-ever and was referred with 35 bmi.

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[Cinnamon16 18]

Update...I was approved by Tricare for the sleeve. I am having surgery tomorrow. I had to pay co-pays and for the nutricianist visit. Please let me know if you have any questions.

[kadi_o 18]

I have tricare prime and had surgery 2 mths ago. However, I had mine at MTF so my program covered everything. Only thing not offered there was psych eval and Tricare prime covered that with no hesitation. Since I did it at mtf, I did not have to wait 3-6 mths that Tricare make some wait. My Dr. referred me for sleeve and I was sleeved 2 mths later. I had no complications what-so-ever and was referred with 35 bmi.

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Did you have to show proof of monthly weigh ins with your pcp?

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